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Table 4 Originally planned implementation support

From: Strengthening methods for tracking adaptations and modifications to implementation strategies

CAP step Specifics of implementation support ERIC category
Step 1. Create an ‘SDH Team.’ Materials for clinic leaders: benefits of SDH documentation / action; leaders’ role in supporting SDH process adoption Recruit, designate, train for leadership; orientation materials
Materials for clinician champion: orientation, step summary materials
Obtain leadership support. Materials for project champion: orientation, step summary materials
Draft email from leadership to clinic staff alerting staff to SDH Plan Technical assistance
Identify, orient clinic champion / study contact. Office hours covering: (1) Orienting champions; (2) Goal setting Identify / prepare champions; recruit, designate, train for leadership; orientation materials; peer-to-peer learning
Check-in: Orientation Technical assistance
Step 2. Identify goals. Materials - Decision tools: Why do you want to collect SDH data? What do you hope to accomplish? What do you plan to do with the SDH data? Which patients do you want to screen? How often? For which SDH? Goal identification / implementation blueprint
Materials - Written recommendations / key considerations for selecting clinic goals Goal identification; technical assistance
Identify clinic’s goals for SDH screening. Summary of the clinic’s stated goals Goal identification
Office hours covering: (1) Goal setting; (2) Learning the EHR tools Goal identification / implementation blueprint; peer-to-peer learning
Identify which patients will be screened for which SDH measures. Check-in: Identify goals Goal identification / implementation blueprint
Step 3. Create an ‘SDH Plan.’ Materials - Planning tools: SDH documentation workflow; SDH data review / action workflow; Workflow implementation rollout Technical assistance
Materials - Resource list (PRAPARE, HealthLeads, etc.)
Create a workflow plan for SDH documentation, and (if desired) SDH data review and action. Materials - Guides to using EHR’s SDH Data Tools: In workflows; in SDH documentation, on site or via patient portal; to review SDH; for SDH referral-making (with guidance on creating a social service resource list)
Materials - Pros and cons of different SDH documentation workflow options; key considerations based on other CHCs’ experience
Create a rollout plan. Materials - Summary of clinic’s stated workflow plan Goal identification / implementation blueprint; technical assistance
Check-in: Workflow development, use of workflow planning tools, rollout plan Technical assistance
Office hours covering: (1) Workflow planning; (2) EHR tools within workflows Peer-to-peer learning; technical assistance
Step 4. Train clinic staff. Materials - Orientation webinar for clinic staff; review clinic’s goals and workflow plan; include staff discussion of potential barriers / how to address them. Educational meeting / materials; goal identification
Orient staff.
Materials - How to orient clinic staff to SDH documentation and action, based on other CHCs’ experiences Educational meeting
If SDH plan changes, orient staff. Materials - Template slides / handouts for updating staff and / or training new staff Educational meeting; technical support
Check-in: How to train staff  
Train new staff as needed. Office hours covering: (1) How to train staff; (2) How to create target population reports and adoption reports Peer-to-peer learning; technical assistance
Step 5. Roll out the ‘SDH Plan’ Materials - Guides: Using SDH Data Tools to review SDH documentation / action data; Using SDH documentation data to track progress; Testing workflows; PDSA cycles Audit and feedback
Review adoption rates on a regular basis. Check-in: Develop strategy for testing workflows, addressing barriers, rollout, review of adoption progress; how to track SDH adoption progress using data tools; how to revise workflows, rollout plan as needed Audit and feedback; technical assistance; practice facilitation / small tests of change; tailor strategies
Data - monthly adoption reports Audit and feedback; tools for quality monitoring
Iterate / revise rollout, workflows as needed. Office hours covering: How to iterate and refine workflows; other topics identified as needed by the clinics or the IST Peer-to-peer learning; technical assistance; ongoing consultation
  1. Abbreviations: SDH social determinants of health, IST Implementation Support Team, Q & A Questions and Answers